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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024:10.1007/s00261-024-04381-x. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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Loffroy R, Mazit A, Comby PO, Falvo N, Tinel C, Chevallier O. Selective Arterial Embolization of Pseudoaneurysms and Arteriovenous Fistulas after Partial Nephrectomy: Safety, Efficacy, and Mid-Term Outcomes. Biomedicines 2023; 11:1935. [PMID: 37509574 PMCID: PMC10377731 DOI: 10.3390/biomedicines11071935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
The primary objective was to evaluate the clinical success rate after endovascular embolization of iatrogenic vascular lesions caused during partial nephrectomy. The secondary objective was to evaluate the technical success and to assess potential effects on renal function. We retrospectively included consecutive patients from our center who underwent selective embolization to treat iatrogenic renal arterial lesions induced during partial nephrectomy between June 2010 and June 2020. The technical and clinical success rates and renal outcomes were collected. We identified 25 patients with 47 pseudoaneurysms and nine arteriovenous fistulas. Among them, eight were treated by coils only, eight by liquid embolization agents only, and nine by both. The technical success rate was 96% after the first attempt and 100% after the second attempt. The median follow-up was 27.1 ± 24.3 months. Clinical success, defined as no need for further hemostatic surgery during follow-up, was also obtained in 96% and 100% of patients with one and two attempts, respectively. Renal function estimated by the modification of diet in renal disease equation did not change significantly despite a mean 13.8% ± 15.1% decrease in kidney functional volume estimated by angiography. No complications were attributable to the endovascular treatment. No significant difference was found across embolization agents; however, the subgroup sizes were small. Endovascular embolization is safe and effective for treating iatrogenic arterial lesions after partial nephrectomy: success rates are high, complications are infrequent, and renal function is maintained. Recommendations by interventional radiology societies are needed to standardize this treatment.
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Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
| | - Pierre-Olivier Comby
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
| | - Claire Tinel
- Department of Nephrology and Renal Transplantation, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 21078 Dijon, France
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Hörer TM, Ierardi AM, Carriero S, Lanza C, Carrafiello G, McGreevy DT. Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes. Semin Vasc Surg 2023; 36:283-299. [PMID: 37330241 DOI: 10.1053/j.semvascsurg.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/19/2023]
Abstract
Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden; Department of Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Örebro, Sweden; Carmel Lady Davis Hospital, Technion Medical Faculty, Haifa, Israel.
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Carriero
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Post Graduate School of Radiology, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - David T McGreevy
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Sciences, Örebro University Hospital and Örebro University, Södra Grev Rosengatan, 701 85 Örebro, Sweden
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4
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Iatrogenic Renal Artery Injury in 90 Cases: Arteriographic Findings and Outcomes after Embolization for Bleeding. J Vasc Interv Radiol 2023; 34:436-444. [PMID: 36414115 DOI: 10.1016/j.jvir.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/19/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate differences in arteriographic findings and outcomes after embolization among patients with a suspected iatrogenic renal arterial injury (IRAI). MATERIALS AND METHODS Patients at the authors' institution who underwent renal arteriography for suspected IRAIs after partial nephrectomy, biopsy, or percutaneous access over a 20-year period were included. Records, imaging, and outcomes were reviewed. Data analysis was performed using the Fisher exact or Kruskal-Wallis test. RESULTS Ninety arteriograms were performed on 83 patients after partial nephrectomy (n = 32), biopsy (n = 27), or percutaneous access (n = 24), including for nephrostomy/ureterostomy and stone removal. The median number of days between the index procedure and arteriogram was highest (15 days) after partial nephrectomy and lowest (5 days) after biopsy (P = .0001). Embolization was performed during 76% of arteriograms. If prearteriographic imaging showed positive results for IRAIs, embolization was performed in 67% versus 33% if imaging showed negative results (P = .005). The transfusion rate was higher after biopsy than after partial nephrectomy or percutaneous access (P = .002). Acute kidney injury after arteriogram occurred in 7% of patients; however, all returned to baseline by 1 week. CONCLUSIONS Despite the different mechanism of IRAIs in partial nephrectomy, biopsy, and percutaneous access, arteriographic findings and outcomes were overall similar among groups. Prearteriographic imaging can help identify IRAIs but cannot supersede the clinical judgment regarding indication for embolization. IRAIs can present acutely or after a long interim, although patients who underwent biopsy presented earlier and more frequently required a blood transfusion. IRAIs can be treated with embolization without permanent deleterious effects on renal function.
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Stein R, Bashir S, Kee-Sampson J. Interventional radiology in renal emergencies: a pictorial essay. Emerg Radiol 2022; 29:409-424. [PMID: 35001206 DOI: 10.1007/s10140-021-02004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022]
Abstract
Renal emergencies necessitate prompt diagnosis and management to stop active bleeding and retain kidney function. Causes of renal emergencies can be classified into traumatic, atraumatic, iatrogenic, and obstructive etiologies. Interventional radiology (IR) has emerged as an acceptable alternative to surgical treatment in the management of renal emergencies due to its minimally invasive nature. With the rise of interventional procedures, there is a need for further discussion of angiographic and fluoroscopic imaging in the setting of renal emergencies.
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Affiliation(s)
- Rachel Stein
- Department of Radiology, University of FL School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA.
| | - Saeed Bashir
- Department of Radiology, University of FL School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
| | - Joanna Kee-Sampson
- Department of Radiology, University of FL School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
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6
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Bagheri SM, Ghadamzadeh M, Chavoshi M. Percutaneous embolization of renal pseudoaneurysms: A retrospective study. Indian J Urol 2022; 38:296-301. [PMID: 36568457 PMCID: PMC9787449 DOI: 10.4103/iju.iju_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction We evaluated the efficacy of the mixture of autologous blood and a hemostatic agent, oxidized regenerative cellulose (ORC), as an alternative material for ultrasound (US)-guided percutaneous embolization of renal pseudoaneurysm (PA). Methods In this retrospective study, consecutive patients diagnosed with renal PA were included. The exclusion criteria were: PA of the main renal artery, tiny PA not visualized on the colour doppler ultrasonography, PA more than 3 cm in max diameter or extracapsular PA with the possibility of massive bleeding, and patients with a history of coagulation disorders. After localizing the PA, a mixture of autologous blood and ORC was injected under US guidance with a 15G coaxial needle. Patients were followed up for at least 6 months. Results Twenty-nine patients with PA were included, of which 26 had a history of percutaneous nephrolithotomy, and three patients had a history of renal biopsy (24 men and five women with an average age of 44.3 years). Gross hematuria was the most common mode of presentation. The mean size of the PA was 16.6 mm and the mean duration of follow-up was 9 months. The clinical and the technical success rate was 100%. The PA could be thrombosed in all the patients with a single-session of injection. No acute (hematoma, infection, and bleeding) or chronic (thromboembolic events, renal cortical atrophy, and recurrence) complications were seen. Conclusion Percutaneous embolization of renal PA under US guidance with a mixture of autologous blood and ORC is an efficient and easily available first-line method to treat this potentially life-threatening condition when endovascular embolization or other expensive thrombotic agents are not available.
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Affiliation(s)
- Seyed Morteza Bagheri
- Department of Radiology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghadamzadeh
- Department of Radiology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,
E-mail:
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7
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Alabat Roca A, Torrecilla Ortíz C, Cuadrado Campaña JM, Colom Freixas S, Fernández-Concha Schwalb J, Beato García S, Alba Rey E, León Guevara D, Vigués Julià F. Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management. Actas Urol Esp 2021; 45:635-641. [PMID: 34764050 DOI: 10.1016/j.acuroe.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24 ± 21 months. Mean time interval between PCNL and ASE was 7.3 ± 4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8 ± 4.6 h in average. CONCLUSION Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.
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Affiliation(s)
- A Alabat Roca
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - C Torrecilla Ortíz
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - J M Cuadrado Campaña
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - S Colom Freixas
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | - S Beato García
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - E Alba Rey
- Área de Angiorradiología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - D León Guevara
- Área de Angiorradiología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - F Vigués Julià
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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8
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Jairam A, King B, Berman Z, Rivera-Sanfeliz G. Non-Permanent Transcatheter Proximal Renal Artery Embolization for a Grade 5 Renal Injury with Delayed Recanalization and Preserved Renal Parenchymal Enhancement. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
<p>Super-selective renal artery embolization is an increasingly popular technique for the management of traumatic, low-grade renal trauma. When performed in distal arterial branches, this intervention enables tissue preservation and arrest of hemorrhage, but it may not be practical in cases of multifocal, high-grade renal injuries. In such cases, surgical nephrectomy remains the more common treatment modality to ensure hemodynamic control. We present the unique case of a patient who presented in hemorrhagic shock following a major trauma that resulted in a grade 5 renal injury treated with complete renal artery embolization using Gelfoam, resulting in hemodynamic stabilization. Interestingly, imaging 1 month after embolization revealed residual enhancement of the inferior pole of the kidney, suggesting reconstitution of flow and partial renal salvage. Ultimately, transcatheter “nephrectomy” with careful selection of a temporary embolic agent may serve as a safe and efficient alternative to surgical nephrectomy with the added possibility of preserving partial renal perfusion and function in the emergent setting.</p>
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9
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Alabat Roca A, Torrecilla Ortíz C, Cuadrado Campaña JM, Colom Freixas S, Fernández-Concha Schwalb J, Beato García S, Alba Rey E, León Guevara D, Vigués Julià F. Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management. Actas Urol Esp 2021; 45:S0210-4806(21)00127-3. [PMID: 34489115 DOI: 10.1016/j.acuro.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months. Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average. CONCLUSION Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.
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Affiliation(s)
- A Alabat Roca
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
| | - C Torrecilla Ortíz
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - J M Cuadrado Campaña
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - S Colom Freixas
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | - S Beato García
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - E Alba Rey
- Área de Angiorradiología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - D León Guevara
- Área de Angiorradiología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - F Vigués Julià
- Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
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10
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Cao C, Kim SY, Kim GH, Shin JH, Nam IC, Alali M, Chu HH, Ko HK. Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage. PLoS One 2021; 16:e0256130. [PMID: 34415949 PMCID: PMC8378688 DOI: 10.1371/journal.pone.0256130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage. MATERIALS AND METHODS This study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated. RESULTS There were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period. CONCLUSION RAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.
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Affiliation(s)
- Chuanwu Cao
- Department of Radiology, The Tenth People’s Hospital, Shanghai, China
| | - So-Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - In Chul Nam
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Changwon, Korea
| | - Meshari Alali
- Department of Radiology, Majmaah University, Almajmaah, Saudi Arabia
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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11
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Giurazza F, Contegiacomo A, Corvino F, Rebonato A, Castiglione D, Palmucci S, Niola R, Basile A. Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures. Diagnostics (Basel) 2021; 11:diagnostics11071256. [PMID: 34359339 PMCID: PMC8305924 DOI: 10.3390/diagnostics11071256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aims to investigate the correlation between computed tomography (CT) and digital subtraction angiography (DSA) findings in patients affected by acute post-traumatic intraparenchymal renal hemorrhages and evaluate their conservative management with superselective embolization. METHODS This retrospective multicenter analysis focuses on patients affected by renal bleedings detected by contrast-enhanced CT and treated with superselective endovascular embolization. CT findings were compared to DSA. Embolization procedural data were analyzed and renal function was evaluated before and after the intervention. RESULTS Twenty-seven patients were retrospectively evaluated in one year. Compared to DSA, CT showed 96.3% diagnostic accuracy in terms of hemorrhage recognition; concerning the type of vascular lesion, there was discrepancy between CT and DSA in five cases. The technical success rate of embolization was 100%, while primary clinical success was 88.9%. The inferior parenchymal third was the most frequent site of renal injury. Microcoils were the most adopted embolics. Renal function did not change significantly before and after embolization. CONCLUSIONS CT has elevated diagnostic accuracy in detecting post-traumatic intraparenchymal renal hemorrhages; in a small percentage, the type of vascular lesion may differ from the findings observed at DSA. In this scenario, superselective embolization presents high clinical success with a low complication rate.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy; (F.C.); (R.N.)
- Correspondence: ; Tel.: +39-0817473828
| | - Andrea Contegiacomo
- Radiology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00136 Rome, Italy;
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy; (F.C.); (R.N.)
| | - Alberto Rebonato
- Radiology Department, Marche Nord Hospital, Piazzale Carlo Cinelli 1, 61121 Pesaro, Italy;
| | - Davide Castiglione
- Radiology 1 Unit, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate, Università degli Studi di Catania, Via S. Sofia 98, 95100 Catania, Italy; (D.C.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Radiology 1 Unit, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate, Università degli Studi di Catania, Via S. Sofia 98, 95100 Catania, Italy; (D.C.); (S.P.); (A.B.)
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131 Naples, Italy; (F.C.); (R.N.)
| | - Antonio Basile
- Radiology 1 Unit, Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate, Università degli Studi di Catania, Via S. Sofia 98, 95100 Catania, Italy; (D.C.); (S.P.); (A.B.)
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12
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Choh N, Bhat M, Shah O, Hafeez I, Shera F, Gojwari T, Shaheen F. Renal Artery Pseudo-aneurysms: Do All of Them Require Endovascular Management? JOURNAL OF GLOBAL RADIOLOGY 2021. [DOI: 10.7191/jgr.2021.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: Our study examines the etiological profile, clinical and imaging features of renal artery pseudo aneurysms (RAPs), as well as the efficacy and need for the angioembolization of RAPs in a resource-constrained setting.
Materials and Methods: A total of 36 patients with RAPs were included in our study. Initial diagnosis was made by Doppler Ultrasonography (USG) followed by CT renal angiography in all cases. DSA was performed in 28 patients, as eight patients showed spontaneous resolution by thrombosis on immediate pre-procedure Doppler study. Angioembolization with a microcoil was performed for 30 aneurysms in 28 patients. Technical success was confirmed at the end of the procedure by a renal angiogram. To assess clinical success, we followed up with patients (with clinical and Doppler USG) for a period of six months.
Results: The most common cause of RAPs in our study was percutaneous nephrolithotomy (PCNL), seen in 21 patients (58.3%), followed by trauma (25%), and partial nephrectomy (11%). All patients presented to us were within 21 days of the etiological event of hematuria or flank pain. USG was able to detect the RAP in 22 cases (61%). CT renal angiography was diagnostic in all patients but failed to demonstrate two additional aneurysms in one patient. RAP size ≤ 4 mm and absence of brisk filling on CT renal angiography was associated with spontaneous resolution in eight patients, probably an indication of the beginning of spontaneous thrombosis. Angioembolization was done using microcoils and showed 100% technical and clinical success.
Conclusion: PCNL is the most common etiological factor for RAPs in our setting. Such patients should have a Doppler USG done prior to discharge from the hospital. CT angiographic flow dynamics (delayed peak enhancement) may be helpful in the identification of RAPs with a high probability of subsequent spontaneous resolution. Angiography followed by embolization using microcoils is the most effective and safe treatment for RAPs with no significant loss of renal parenchyma, although cost remains a limiting factor in our setting.
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Affiliation(s)
| | | | - Omair Shah
- Sheri Kashmir Institute of Medical Sciences
| | | | - Faiz Shera
- Sheri Kashmir Institute of Medical Sciences
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13
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Kersjes W, Bengel A, Jurczok A. [Treatment of Renal Artery Perforation with Covered Stent after Percutaneous Biopsy of Pancreatic Head]. Dtsch Med Wochenschr 2021; 146:759-762. [PMID: 34062594 DOI: 10.1055/a-1427-8892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HISTORY AND CLINICAL FINDING In a 67-year-old female patient with upper abdominal pain, computed tomography showed a partly calcified swelling of the pancreatic head and wall thickening of the duodenum. EXAMINATIONS Inpatient physical examination findings were normal. Laboratory showed increased pancreatic enzymes (amylase 210 U/l [Standard range: 28-100 U/l], lipase 2115 U/l [Standard range: 23-300 U/l]) and inflammation values (CRP 11.7 mg/l [Standard range: < 5.0 mg/l]), otherwise largely normal laboratory parameters. In the esophago-gastro-duodenoscopy, biopsy of swollen, partly stenosing mucous membrane areas in the duodenum was performed. DIAGNOSIS Histology revealed partial erosive duodenitis, no evidence of a malignant tumor. If chronic calcifying pancreatitis was suspected, a sonographically guided percutaneous biopsy of the pancreatic head was performed to exclude a tumor. TREATMENT AND COURSE Post-biopsy, the patient developed abdominal pain and temporary circulatory instability with nausea/vomiting and a drop in Hb to 7.5 g/dl [Standard range: 12.3-15.3 g/dl]. The sonographic suspicion of a retroperitoneal hematoma was confirmed by computed tomography. The cause was a haemorrhage from a renal artery perforation on the right side, which could be stopped by immediate angiographic intervention with a covered stent. CONCLUSION After percutaneous biopsy, vascular perforation must always be considered. Computed tomography provides a reliable and quick diagnosis. Minimally invasive percutaneous insertion of a covered stent is the therapy of choice in the case of a renal artery accessible to stents.
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Affiliation(s)
- Wilhelm Kersjes
- Institut für Diagnostische und Interventionelle Radiologie, RKH Klinikum Ludwigsburg
| | - Andreas Bengel
- Institut für Diagnostische und Interventionelle Radiologie, RKH Klinikum Ludwigsburg
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14
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Salvatori F, Macchini M, Rosati M, Boscarato P, Alborino S, Paci E, Candelari R. Endovascular management of vascular renal injuries: outcomes and comparison between traumatic and iatrogenic settings. Urologia 2021; 89:167-175. [PMID: 34011230 DOI: 10.1177/03915603211017886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the efficacy of endovascular treatment for vascular renal injuries (VRIs) like bleeding, pseudoaneurysm and artero-venous fistula (AVF) and to compare patients with blunt trauma (T-VRIs) with those with iatrogenic damage (I-VRIs). METHODS We retrospectively assessed 49 renal artery embolizations performed to treat T-VRIs (26.5%) and I-VRIs (73.5%). Different embolic materials were used based on the type of lesion. Technical success was defined as the complete occlusion of target arteries with no further visualization of VRIs. Clinical success was defined if no recurrence was present and if renal function (difference between creatinine after and before treatment <0.5 mg/dl) was preserved after 1 month. RESULTS Angiography showed bleeding in 27 patients, pseudoaneurysm in 29 and an AVF in 6. Embolic agents used were coils in 39 procedures, coils with sponge in four and others in six. Technical success was 100% while clinical success was 85.7% due to seven patients with recurrence. The group I-VRIs showed a higher rate of clinical success than the group T-VRIs (94.4% vs 61.5%; p < 0.05). Moreover, the group I-VRIs had a higher incidence of pseudoaneurysms and AVFs compared with the group T-VRIs (69.4% vs 30.8% and 16.7% vs 0%; p < 0.05). CONCLUSION Endovascular treatment for VRIs showed satisfactory results and no patient had a worsening of renal function. I-VRIs had better clinical success and more frequently appeared as pseudoaneurysms compared to T-VRIs: probably iatrogenic injury is localized and pseudoaneurysm is easily identifiable and treatable with endovascular treatment.
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Affiliation(s)
- Fabio Salvatori
- Interventional Radiology, Ospedale Generale Provinciale di Macerata, Macerata, Italy
| | - Marco Macchini
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, Ancona, Italy
| | - Marzia Rosati
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, Ancona, Italy
| | - Pietro Boscarato
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, Ancona, Italy
| | - Salvatore Alborino
- Interventional Radiology, Ospedale Generale Provinciale di Macerata, Macerata, Italy
| | - Enrico Paci
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, Ancona, Italy
| | - Roberto Candelari
- Interventional Radiology, Department of Radiology, Az. Osp-Univ OORR-Torrette, Ancona, Italy
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15
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Abstract
Traumatic injuries to the kidney and collecting system can range widely from small lacerations to significant bleeding and its sequelae. Urinary obstruction can occur in the renal pelvis, ureters, or urethra. Interventional radiology plays a significant role in treatment and management, in many cases requiring emergent action. Endovascular embolization is frequently the first-line approach to treating hemorrhage. Percutaneous interventions for urinary obstruction include nephrostomy and suprapubic catheter placement. In this article, we outline the clinical approach and interventional methods used in the evaluation and treatment of renal trauma. Several case presentations demonstrate the role of interventional radiology in renal trauma.
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Affiliation(s)
- Diego B Lopez-Gonzalez
- Division of Interventional Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Omar Zurkiya
- Division of Interventional Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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16
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Vorobev V, Beloborodov V, Golub I, Frolov A, Kelchevskaya E, Tsoktoev D, Maksikova T. Urinary System Iatrogenic Injuries: Problem Review. Urol Int 2021; 105:460-469. [PMID: 33535218 DOI: 10.1159/000512882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. METHODS The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. "Overlooked" urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11-36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6-1.5%). RESULTS Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. DISCUSSION/CONCLUSION Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.
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Affiliation(s)
- Vladimir Vorobev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation,
| | - Vladimir Beloborodov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Igor Golub
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Aleksandr Frolov
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Elena Kelchevskaya
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Darizhab Tsoktoev
- Department of General Surgery and Anesthesiology, Irkutsk State Medical University, Irkutsk, Russian Federation
| | - Tatyana Maksikova
- Department of Propedeutics of Internal Diseases, Irkutsk State Medical University, Irkutsk, Russian Federation
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17
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Nishiyama H, Matsumoto H, Izawa D, Toki N. Renal Artery Injury Caused by a 0.035-Inch Guidewire in Navigating a Guiding Sheath during Coil Embolization: A Case Report of Rescue Embolization with n-Butyl-2-Cianoacrylate. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:58-63. [PMID: 37503453 PMCID: PMC10370614 DOI: 10.5797/jnet.cr.2019-0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/29/2020] [Indexed: 07/29/2023]
Abstract
Objective We report renal artery injury by a guidewire during coil embolization of a cerebral artery aneurysm, which was successfully treated by transarterial embolization using n-butyl-2-cianoacrylate (NBCA). Case Presentation A 65-year-old woman underwent coil embolization for an unruptured cerebral aneurysm, resulting in its complete occlusion. However, her blood pressure decreased during embolization and postoperative abdominal computed tomography (CT) revealed a retroperitoneal hematoma. Intraoperative video revealed that the 0.035-inch guidewire had passed deeply into the right renal artery when the guiding sheath was navigated into the abdominal aorta, suggesting renal artery perforation. Transarterial embolization using NBCA was performed immediately, which resulted in hemostasis. Conclusion Although renal artery perforation with a guidewire is a rare complication, it can have severe consequences. Early diagnosis with prompt and definitive hemostasis is important.
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Affiliation(s)
- Hirokazu Nishiyama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Hiroyuki Matsumoto
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Daisuke Izawa
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Naotsugu Toki
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
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18
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Limtrakul T, Rompsaithong U, Ahooja A, Kiatsopit P, Lumbiganon S, Pachirat K, Sirithanaphol W. Renal Artery Embolization for Acute Renal Hemorrhage: A Single-Center Experience. Res Rep Urol 2020; 12:315-319. [PMID: 32802808 PMCID: PMC7415436 DOI: 10.2147/rru.s263012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Emergency renal artery embolization (RAE) is a useful method in treating renal trauma and bleeding renal tumors. The aim of this study was to evaluate the clinical efficacy and safety of emergency RAE, and factors associated with RAE failure. Methods This retrospective study included patients treated with emergency RAE for acute renal hemorrhage between 1 January 2009 and 31 October 2019 in Srinagarind Hospital. The embolization was performed using coils, glues, and/or gel foams. Factors associated with unsuccessful outcomes were analyzed using univariate and multivariate regression analyses. Results A total of 94 patients were treated at the center during the study period with the clinical success rate of 91.5%. The most common cause of acute renal hemorrhage was iatrogenic injury (76.5%). Factors associated with unsuccessful RAE according to multivariate analyses were hypertension (adjusted odds ratio [AOR] 24.2) and ruptured tumor/aneurysm (AOR 26.8). Conclusion RAE is an effective procedure for acute renal hemorrhage. Hypertension and ruptured tumor/aneurysm were negative predictors for success.
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Affiliation(s)
- Tanapoom Limtrakul
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ukrit Rompsaithong
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anucha Ahooja
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pakorn Kiatsopit
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supanut Lumbiganon
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kachit Pachirat
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wichien Sirithanaphol
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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19
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Ierardi AM, Piacentino F, Pesapane F, Carnevale A, Curti M, Fontana F, Venturini M, Pinto A, Gentili F, Guerrini S, De Filippo M, Giganti M, Carrafiello G. Basic embolization techniques: tips and tricks. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:71-80. [PMID: 32945281 PMCID: PMC7944672 DOI: 10.23750/abm.v91i8-s.9974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
Good knowledge of the various approaches of embolization of peripheral bleedings and different embolic materials available is of paramount importance for successful and safe embolization. We review and illustrate the main endovascular and percutaneous techniques used for embolization, along with the characteristics of the different embolic materials, and the potential complications.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Filippo Pesapane
- Breast Imaging Unit, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Aldo Carnevale
- University Radiology Unit, Radiology Department, Arcispedale Sant'Anna, Via A. Moro 8, Ferrara, 44123, Italy.
| | - Marco Curti
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Federico Fontana
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda dei Colli, Naples, Italy.
| | - Francesco Gentili
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Susanna Guerrini
- Department of Radiological Sciences, Diagnostic Imaging Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
| | - Massimo De Filippo
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy.
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Radiology Section, University of Ferrara, Via L. Ariosto 35, Ferrara, 44121, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan and Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
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20
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Jardinet T, Bonne L, Oyen R, Maleux G. Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization. Vasc Endovascular Surg 2020; 54:240-246. [DOI: 10.1177/1538574419897500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Methods: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients’ demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients’ electronic medical records. Results: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. Conclusion: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure.
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Affiliation(s)
- Thomas Jardinet
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Raymond Oyen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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21
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Contegiacomo A, Amodeo EM, Cina A, Di Stasi C, Iezzi R, Coppolino D, Attempati N, Manfredi R. Renal artery embolization for iatrogenic renal vascular injuries management: 5 years' experience. Br J Radiol 2019; 93:20190256. [PMID: 31794248 DOI: 10.1259/bjr.20190256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. METHODS Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. RESULTS 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI.The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028).Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016).No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). CONCLUSION RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. ADVANCES IN KNOWLEDGE Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.
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Affiliation(s)
- Andrea Contegiacomo
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Maria Amodeo
- Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Cina
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Carmine Di Stasi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Roberto Iezzi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Davide Coppolino
- Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Nico Attempati
- Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
| | - Riccardo Manfredi
- Department of Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Radiological Sciences, Università Cattolica Sacro Cuore, Rome, Italy
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22
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Lee SY, Wang ML, Wong YC, Wu CH, Wang LJ. Prolonged international normalized ratio and vascular injury at divisional level predict embolization failures of patients with iatrogenic renal vascular injuries. Sci Rep 2019; 9:17108. [PMID: 31745170 PMCID: PMC6864247 DOI: 10.1038/s41598-019-53561-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022] Open
Abstract
Transcatheter arterial embolization (TAE), as an alternative to surgery for iatrogenic renal vascular injury (IRVI), may have unsatisfactory outcomes. Nonetheless, there is inadequate information regarding the predictors of TAE outcomes for IRVI in the literature. The aim of this retrospective study was to investigate the predictors of TAE outcomes for IRVI. Of 47 patients, none had major complications, 17 (36.2%) patients had minor complications, and none suffered significant renal function deterioration after TAE. Technical success and clinical success were 91.5% and 93.6%, respectively. Technical failure was associated with older age, thrombocytopenia, prolonged international normalized ratio (INR) and divisional IRVI. Clinical failure was associated with kidney failure, use of steroids, prolonged INR, and divisional IRVI. In addition, prolonged INR was a significant predictor of technical failure. This implies that aggressive measures to control the INR prior to TAE are warranted to facilitate technical success, and technical success could then be validated on post-TAE images. Furthermore, divisional IRVI was a predictor of clinical failure. Thus, divisional IRVI should undergo surgery first since TAE is prone to clinical failure. The avoidance of clinical failure is validated if divisional IRVI does not need further intervention.
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Affiliation(s)
- Shen-Yang Lee
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Lin Wang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yon-Cheong Wong
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsian Wu
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Wang
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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23
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Ierardi AM, Pesapane F, Arrichiello A, Fontana F, Piacentino F, Carrafiello G. Migration of Ethylene Vinyl Alcohol Co-Polymer in the Urinary Tract Successfully Managed. ACTA ACUST UNITED AC 2019; 55:medicina55060234. [PMID: 31159307 PMCID: PMC6630371 DOI: 10.3390/medicina55060234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 01/15/2023]
Abstract
Selective embolization is the treatment of choice for traumatic renal pseudoaneurysm. The use of ethylene vinyl alcohol copolymer (EVOH) was recently described as an embolic agent in peripheral lesions. The aim of a good embolic agent is to: achieve rapid and effective embolization; reach and fill distal vasculature targeted for embolization; be easy to prepare and use. Moreover, it should be highly radiopaque, controllable during administration, biocompatible and cost-effective. EVOH is a non-adhesive embolic agent and its efficacy is independent from the coagulant status. The risk of non-targeted embolization should be reduced by the good radio-opacity of the embolic material that is injected under continuous fluoroscopy. Nevertheless, symptomatic EVOH migration was described. We report a unique case of embolization of a renal pseudoaneurysm and migration of EVOH in the urinary tract. Retrograde trans-urethral removal of the migrated embolic agent was successfully performed. Our case report indicates that EVOH may not be appropriate when a fistula with renal calyx is suspected, even if its migration in the urinary tract may be managed.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
| | - Filippo Pesapane
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy.
| | - Antonio Arrichiello
- Diagnostic and Interventional Radiology Department, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
| | - Federico Fontana
- Radiology Department, Insubria University, Viale Borri 57, 21100 Varese, Italy.
| | - Filippo Piacentino
- Radiology Department, Insubria University, Viale Borri 57, 21100 Varese, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.
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Haochen W, Jian W, Li S, Tianshi L, Xiaoqiang T, Yinghua Z. Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience. J Int Med Res 2019; 47:1649-1659. [PMID: 30760109 PMCID: PMC6460605 DOI: 10.1177/0300060519828528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy. METHODS From January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization. RESULTS Successful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization. CONCLUSIONS Superselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.
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Affiliation(s)
- Wang Haochen
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Wang Jian
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Song Li
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Lv Tianshi
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Tong Xiaoqiang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Zou Yinghua
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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Fergus KB, Baradaran N, Tresh A, Conrad MB, Breyer BN. Use of angioembolization in urology: a review. Transl Androl Urol 2018; 7:535-544. [PMID: 30211044 PMCID: PMC6127546 DOI: 10.21037/tau.2018.05.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/14/2018] [Indexed: 01/10/2023] Open
Abstract
This review discusses current and developing indications for angioembolization (AE) techniques in urology cases, including trauma and non-trauma uses for kidney, prostate, and bladder conditions. AE methods, complications and technical and clinical outcomes are outlined for each indication for the purpose of aiding urologists in selecting ideal candidates for this procedure.
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Affiliation(s)
- Kirkpatrick B. Fergus
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Anas Tresh
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Miles B. Conrad
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Benjamin N. Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
- Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA
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Are iatrogenic renal artery pseudoaneurysms more challenging to embolize when associated with an arteriovenous fistula? Radiol Med 2018; 123:742-752. [DOI: 10.1007/s11547-018-0906-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/20/2018] [Indexed: 12/25/2022]
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Pinto A, Berritto D, Russo A, Riccitiello F, Caruso M, Belfiore MP, Papapietro VR, Carotti M, Pinto F, Giovagnoni A, Romano L, Grassi R. Traumatic fractures in adults: missed diagnosis on plain radiographs in the Emergency Department. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:111-123. [PMID: 29350641 PMCID: PMC6179080 DOI: 10.23750/abm.v89i1-s.7015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
Radiography remains the imaging standard for fracture detection after trauma. The radiographic diagnosis of most fractures and dislocations poses little difficulty to radiologists: however, occasionally these injuries are quite subtle or even impossible to detect on radiographs. Missed diagnoses of fracture potentially have important consequences for patients, clinicians, and radiologists. Radiologists play a pivot role in the diagnostic assessment of the trauma patients: emergency radiologists who are more practiced at seeking out and discerning traumatic fractures can provide an invaluable service to their clinical colleagues by ensuring that patients do not endure delayed diagnoses. This is a narrative review article aims to highlight the spectrum of fractures in adults potentially missed on plain radiographs, the causes of error in diagnosis of fractures in the emergency setting and the key elements to reduce misdiagnosis of fractures.
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Corvino F, Giurazza F, Cangiano G, Cavaglià E, Amodio F, De Magistris G, Corvino A, Niola R. Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries. Radiol Med 2017; 123:369-377. [PMID: 29256083 DOI: 10.1007/s11547-017-0844-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/11/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Demonstrate the role of endovascular management in the treatment of internal mammary artery (IMA) injuries using transcatheter embolization reviewing our 7-year experience. MATERIALS AND METHODS Our retrospective analysis of cases consists of a total of 12 patients (8 M and 4 F; mean age 52 years) who underwent angiographic studies and transcatheter embolization for IMA injuries. Causes of vascular injury were divided in high-energy trauma (n = 6), iatrogenic (n = 3) and penetrating injuries (n = 3). Type of trauma, associated injury, imaging findings, treatments and complications were assessed. Imaging findings included active haemorrhage, pseudoaneurysm and focal dissection. RESULTS Embolization was performed with microcoils in all patients; complete thrombosis was obtained in four patients by additional injection of Spongostan pledgets and in two patients with 300-500 μm particles. The technical success rate was 100%. No patient died as a direct result of vascular injury; one died of myocardial contusion and one for severe multiorgan failure related to high-energy trauma. No major and minor complications were registered. No patient required emergency surgery or subsequent surgical treatment. CONCLUSION Transcatheter embolization offers an effective, efficient and safe alternative to conventional surgical management of IMA injuries.
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Affiliation(s)
- Fabio Corvino
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Francesco Giurazza
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Gianluca Cangiano
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Enrico Cavaglià
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Francesco Amodio
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Giuseppe De Magistris
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
| | - Antonio Corvino
- Department of Radiology, University of Naples Parthenope, Naples, Italy
| | - Raffaella Niola
- Interventional Radiology Department, AORN "A. Cardarelli", Via A. Cardarelli 9, 80131, Naples, Italy
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Abstract
The kidneys are paired intra-abdominal organs which provide essential functions and maintain homeostasis throughout the human body. Numerous disease processes affect the kidneys and cause acute renal dysfunction or other potentially catastrophic complications. These conditions can be broadly categorized into obstructive, infectious, hemorrhagic, traumatic, and vascular diseases. Imaging plays a vital role in the work-up and diagnosis of acute and emergent renal conditions. Evaluation of emergent renal conditions with a focus on CT imaging is discussed.
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Affiliation(s)
- Kunal Kothari
- Department of Radiology, Hofstra Northwell School of Medicine, New Hyde Park, NY.
| | - John J Hines
- Department of Radiology, Hofstra Northwell School of Medicine, New Hyde Park, NY
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Guo H, Wang C, Yang M, Tong X, Wang J, Guan H, Song L, Zou Y. Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization: A single center analysis and outcomes. Medicine (Baltimore) 2017; 96:e8187. [PMID: 28984770 PMCID: PMC5738006 DOI: 10.1097/md.0000000000008187] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to evaluate the efficacy and safety of transarterial embolization (TAE) for iatrogenic renal arterial pseudoaneurysm and arteriovenous fistula at our center.Our retrospective analysis included 27 patients who received TAE for iatrogenic renal arterial pseudoaneurysm and arteriovenous fistula between January 2006 and January 2016. Data on demographics, type of minimally invasive renal procedures, clinical manifestation, imaging features, embolization procedure, and perioperative details were collected. The technical and clinical success rates were analyzed. Furthermore, the changes in serum creatinine and eGFR before and after embolization were recorded and compared by t test.The median time between iatrogenic renal injury and TAE was 3 days (range, 0-110 days), with most patients (24/27, 88.9%) receiving TAE within 14 days. Only 1 patient was diagnosed with renal artery pseudoaneurysm 110 days after laproscopic partial nephrectomy. The technical and clinical success rates were 100% and 96.3%, respectively, with 1 patient requiring a second embolotherapy at the third postoperative day. No other patient required additional endovascular or surgical intervention due to recurrent hemorrhage. The mean serum creatinine before TAE was 92.8 ± 25.3 μmol/L and after TAE, 96.1 ± 27.7 μmol/L (P = .095). The eGFR of pre- and postembolization was 75.2 ± 26.5 mL/min/1.73 m and 72.5 ± 26.2 mL/min/1.73 m (P = .16). No severe complications were observed during follow-up.This retrospective review demonstrated that TAE for the treatment of iatrogenic renal artery pseudoaneurysm and/or arteriovenous fistula was safe and associated with high technical and clinical success rate.
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Loffroy R, Chevallier O, Gehin S, Midulla M, Berthod PE, Galland C, Briche P, Duperron C, Majbri N, Mousson C, Falvo N. Endovascular management of arterial injuries after blunt or iatrogenic renal trauma. Quant Imaging Med Surg 2017; 7:434-442. [PMID: 28932700 DOI: 10.21037/qims.2017.08.04] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according to the size of laceration and its proximity to the renal hilum. Arteriovenous fistula and pseudoaneurysm are the most common iatrogenic biopsy-related or surgery-related vascular injuries in native kidneys. The approach to renal artery injuries has changed over time from more aggressive intervention to more conservative observational or endovascular management, including selective transcatheter arterial embolization (TAE) and the placement of stents/stent grafts. In this article, we describe the role and technical aspects of endovascular interventions in the management of arterial injuries after blunt or iatrogenic renal trauma.
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Affiliation(s)
- Romaric Loffroy
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Olivier Chevallier
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Sophie Gehin
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Marco Midulla
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Pierre-Emmanuel Berthod
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Christophe Galland
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Pascale Briche
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Céline Duperron
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Nabil Majbri
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Christiane Mousson
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
| | - Nicolas Falvo
- 1Department of Vascular and Interventional Radiology, 2Department of Urology and Andrology, 3Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, Dijon, France
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Mafeld S, McNeill M, Haslam P. Percutaneous perirenal thrombin injection for the treatment of acute hemorrhage after renal biopsy. Diagn Interv Radiol 2017; 22:190-2. [PMID: 26809832 DOI: 10.5152/dir.2015.15241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies.
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Belfiore G, Belfiore MP, Reginelli A, Capasso R, Romano F, Ianniello GP, Cappabianca S, Brunese L. Concurrent chemotherapy alone versus irreversible electroporation followed by chemotherapy on survival in patients with locally advanced pancreatic cancer. Med Oncol 2017; 34:38. [DOI: 10.1007/s12032-017-0887-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/11/2017] [Indexed: 01/20/2023]
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Gonzalez-Aguirre AJ, Durack JC. Managing Complications Following Nephron-Sparing Procedures for Renal Masses. Tech Vasc Interv Radiol 2016; 19:194-202. [PMID: 27641453 DOI: 10.1053/j.tvir.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Small renal malignancies are commonly treated with nephron-sparing procedures including partial nephrectomy and percutaneous ablation. Although these procedures offer faster patient recovery and preserve renal function, a variety of complications can occur. Here, we review vascular and nonvascular complications associated with nephron-sparing renal mass treatments and discuss options for minimally invasive image-guided management.
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Affiliation(s)
- Adrian J Gonzalez-Aguirre
- Department of Radiology, Interventional Radiology Section, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeremy C Durack
- Department of Radiology, Interventional Radiology Section, Memorial Sloan Kettering Cancer Center, New York, NY.
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Reginelli A, Capasso R, Ciccone V, Croce MR, Di Grezia G, Carbone M, Maggialetti N, Barile A, Fonio P, Scialpi M, Brunese L. Usefulness of triphasic CT aortic angiography in acute and surveillance: Our experience in the assessment of acute aortic dissection and endoleak. Int J Surg 2016; 33 Suppl 1:S76-84. [DOI: 10.1016/j.ijsu.2016.05.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Un S, Cakir V, Kara C, Turk H, Kose O, Balli O, Yilmaz Y. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy. Can Urol Assoc J 2015; 9:E594-8. [PMID: 26425220 DOI: 10.5489/cuaj.2803] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the primary surgical intervention in kidney stone management. Even though it is performed quite often, the complication rates are also high. Arteriovenous fistulas following extended hemorrhages after PCNL are one of the most serious complications of this operation. Our main objective was to review the data of patients who required angiography and embolization. METHODS In total, we included 1405 patients who underwent PCNL between 2007 and 2014. All patient data were retrospectively reviewed. All patients went under PCNL using fluoroscopy. Following informed consent, all hemorrhagic patients underwent angiography in the interventional radiology department and embolization was performed in patients with a hemorrhage focus point. RESULTS A total of 147 patients (10.4%) required transfusion for post-PCNL hemorrhages. Of them, 14 (0.99%) underwent angiography and embolization (9 [64.2%] were male and 5 [35.8%] were female, with a mean age of 39.4 ± 10.2). The remaining 133 patients were conservatively managed (81 [60.9%] males and 52 [39.1%] females, with a mean age of 42.3 ± 12.4). When the predicting factors for angiography and embolization were reviewed, renal abnormalities and the mean size of stones were significant in both univariate and multivariate analysis (p < 0.001). CONCLUSION Patients with extended and intermittent hematuria should be monitored closely for hemodynamics; if there is an ongoing necessity for transfusion, angiography should be considered.
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Affiliation(s)
- Sitki Un
- Department of Urology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Volkan Cakir
- Department of Radiology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Cengiz Kara
- Department of Urology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Hakan Turk
- Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Osman Kose
- Department of Urology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Omur Balli
- Department of Radiology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey
| | - Yuksel Yilmaz
- Department of Urology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey
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Tonolini M, Ierardi AM, Varca V, Incarbone GP, Petullà M, Bianco R. Multidetector CT imaging of complications after laparoscopic nephron-sparing surgery. Insights Imaging 2015; 6:465-78. [PMID: 26104123 PMCID: PMC4519814 DOI: 10.1007/s13244-015-0413-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose Laparoscopic nephron-sparing surgery (L-NSS) is increasingly performed to treat localised renal lesions. However, the associated morbidity is non-negligible, with a rate of major complications approaching 10 %. Methods and Results This paper provides an overview of indications, surgical techniques and results of L-NSS; explains the incidence, risk factors and manifestations of postoperative complications; discusses the preferred multidetector computed tomography (CT) acquisition techniques; illustrates the appearance of normal postoperative images following L-NSS; and reviews, with example images, the most common and unusual iatrogenic complications. These include haematuria, haemorrhage, vascular injuries, infections and urinary leaks. Most emphasis is placed on CT, which provides rapid, reliable triage and follow-up of iatrogenic complications after L-NSS, identifying occurrences that require transarterial embolisation or repeated surgery. Conclusions Multidetector CT allows precise assessment of the surgical resection site; detection of pneumoperitoneum and subcutaneous emphysema; quantification of retroperitoneal blood; and identification of active bleeding, pseudoaneurysms, arterio-venous fistulas, abscess collections and extravasated urine. Teaching Points • Laparoscopic nephron-sparing surgery (NSS) is increasingly performed to treat renal lesions. • Radiologists are increasingly requested to investigate suspected post-surgical NSS complications. • Post-NSS complications include haemorrhage, haematuria, vascular injuries, infections and urinary leaks. • Multidetector CT allows choice between conservative treatment, transarterial embolisation or surgery.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy,
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Esparaz AM, Pearl JA, Herts BR, LeBlanc J, Kapoor B. Iatrogenic urinary tract injuries: etiology, diagnosis, and management. Semin Intervent Radiol 2015; 32:195-208. [PMID: 26038626 PMCID: PMC4447880 DOI: 10.1055/s-0035-1549378] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries.
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Affiliation(s)
- Anthony M. Esparaz
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Brian R. Herts
- Department of Abdominal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin LeBlanc
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Culp WTN, Mayhew PD, Pascoe PJ, Zwingenberger A. ANGIOGRAPHIC ANATOMY OF THE MAJOR ABDOMINAL ARTERIAL BLOOD SUPPLY IN THE DOG. Vet Radiol Ultrasound 2015; 56:474-85. [DOI: 10.1111/vru.12250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/25/2015] [Indexed: 12/13/2022] Open
Affiliation(s)
- William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; One Shields Avenue Davis CA 95616
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; One Shields Avenue Davis CA 95616
| | - Peter J. Pascoe
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; One Shields Avenue Davis CA 95616
| | - Allison Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; One Shields Avenue Davis CA 95616
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Ierardi AM, Floridi C, Pellegrino C, Petrillo M, Pinto A, Iadevito I, Golia E, Perillo A, Grassi R, Rotondo A, Carrafiello G. Role of percutaneous transcatheter embolization (PTE) in the treatment of spontaneous bleeding associated with anticoagulant therapy. Radiol Med 2014; 120:149-57. [PMID: 25388991 DOI: 10.1007/s11547-014-0470-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/27/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate safety and clinical efficacy of percutaneous transcatheter embolization (PTE) in the treatment of spontaneous bleedings (SBs) in patients submitted to chronic anticoagulation therapy. MATERIALS AND METHODS From January 2007 to December 2012, 20 patients (mean age 75.8 years, range 68-91 years) with 23 SBs were retrospectively evaluated. Active bleeding was documented by contrast enhanced-multidetector row computed tomography (CE-MDCT). PTE was performed using different embolic agents. Technical success (TS), clinical success (CS), late success (LS) and mortality rate (M) related to the angiographic procedure and complications were evaluated. RESULTS CE-MDCT and digital subtraction angiography (DSA) identified active bleeding sites in 18 cases (18/20). In two cases (2/20) DSA did not confirm the arterial bleeding diagnosed on CE-MDCT. Twenty-three sessions of PTE were performed. TS, CS, LS and M were, respectively, 100, 85, 15 and 0%. No major complications were observed. CONCLUSIONS PTE could be considered a safe and effective "first line" approach to treat SB associated with anticoagulation therapy.
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Affiliation(s)
- Anna Maria Ierardi
- Interventional Radiology-Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy
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Cross-sectional imaging of iatrogenic complications after extracorporeal and endourological treatment of urolithiasis. Insights Imaging 2014; 5:677-89. [PMID: 25256564 PMCID: PMC4263803 DOI: 10.1007/s13244-014-0355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/27/2014] [Accepted: 09/02/2014] [Indexed: 11/25/2022] Open
Abstract
Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) currently represent the mainstay treatment options for the vast majority of patients with urolithiasis, with limited contraindications and high success rates. However, minimally invasive extracorporeal and endourological treatments are associated with a non-negligible morbidity including occasional life-threatening occurrences. These complications represent a source of concern for urologists since they may result in prolonged hospitalisation, need for surgical, endoscopic or interventional treatment, long-term renal impairment, and sometimes even medical malpractice claims. Due to the increasing prevalence of urolithiasis and the large number of therapeutic procedures performed, in hospitals with active urologic practices radiologists are increasingly requested to investigate suspected post-procedural complications following ESWL, PCNL or ureteroscopic stone removal. Based upon our experience, this pictorial essay provides an overview of current extracorporeal and endourological treatment modalities for urolithiasis, including indications and possible complications according to the most recent guidelines from the European Association of Urology (EAU). Afterwards, we review the clinical features and cross-sectional imaging appearances of common and unusual complications with case examples, including steinstrasse, subcapsular, perirenal and suburothelial haemorrhages, severe urinary tract infections (such as pyeloureteritis, pyelonephritis, renal abscesses and pyonephrosis), ureteral injuries and delayed strictures. Teaching points • Extracorporeal lithotripsy, percutaneous nephrolitotomy and ureteroscopy allow treating urolithiasis. • Minimally invasive extracorporeal and endourological treatment have non-negligible morbidity. • Multidetector CT allows confident assessment of stone-free status and postprocedural complications. • Main complications include steinstrasse, bleeding, severe infections, ureteral injuries and strictures. • Imaging triage allows the choice among conservative, surgical, endoscopic or interventive treatment.
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